Provider Demographics
NPI:1407919947
Name:MOSES, ROBERT KEVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KEVIN
Last Name:MOSES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 CLAYHALL ST
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-6501
Mailing Address - Country:US
Mailing Address - Phone:301-947-2495
Mailing Address - Fax:
Practice Address - Street 1:457 CLAYHALL ST
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-6501
Practice Address - Country:US
Practice Address - Phone:301-947-2495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ394OtherCAREFIRST BLUE CROSS
MD71-0998027Medicare UPIN